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ELIZABETH A. NEVILLE �#A • Town Hall, 53095 Main Road
TOWN CLERK ; ? P.O. Box 1179
REGISTRAR OF VITAL STATISTICSSouthold, New York 11971
MARRIAGE OFFICER : o� � . 'f���1', Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER 44/ 0.
�•III Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - . /o/
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2541 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL SERVICE
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION OF OVELOW TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner MCKIEON, KIM
Mailing Address 1 1775 OLD ORCHARD LANE
City St Zip EAST MARION NY 11939
Property Address 1 1775 OLD ORCHARD LANE
City St Zip EAST MARION NY 11939
Tax Map No. section 37.00 block 3 lot 12.001
Cross Street
Building Permit Number Cross Reference:
Issue Date: 4/16/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
kof Fag (93 (
ELIZABETH A. NEVILLE t"�kk. Town Hall 53095 Main Road
M
TOWN CLERK .r � ,_ytF' '
1 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ,a �� Southold, New York 11971
MARRIAGE OFFICER :"AV/
�`� �1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ®`� ,.00
'��/'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 28, 2001
Transmitted herewith is a copy of application No. 2629 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Morris Cesspool for Kimberly McKeon
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
* * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPR ✓
OVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
ignature
a
Dated
•
OFFICE OF THE TOWN CLERK '' AFF OLk
TOWN OF SOUTHOLD t���''��J V ; Application No. el(de, 9
ELIZABETH A.NEVILLE,TOWN CLERK 47
P.O.BOX 1179 ;,
•
P • rn Construction
SOUTHOLD,NEW YORK 11971
=3 Alteration fl
Telephone - 0-(
0 � $10.00 - Residential
st
(631) 765-1800 =��1' �'' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION •
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE Au 2C o /
APPLICANT NAME: A)74-e.; .ems(
APPLICANT ADDRESS: �t ,2-e
-51
SEPTIC CESSPOOL-4
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: •
OWNER OF PROPERTY:
OWNEI3 MAILING ADDRESS: Vth ,oe/or )/✓
OWNER PROPERTY ADDRESS: `��
TELEPHONE NUMBER OF CONTACT PERSON: 7;c Jac
TAX MAP NO. : Section 9 7 Block 3 Lot lZ -/
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
0(,74? Awlnature of Applicant
/J.
RECEIVED BY:
Town CI rk's Office
DATE: j La�
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